PET Scan Tumor Uptake Predicts 10-Year Survival in Early Breast Cancer

Pretreatment tumor uptake measured on fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) was associated with long-term recurrence-free and overall survival in patients with early-stage estrogen receptor-positive, human epidermal growth factor receptor 2-negative breast cancer, according to a retrospective study published in Breast Cancer Research. The finding, reported by Hiroko Tsukada and colleagues, suggests that the maximum standardized uptake value (SUVmax) of the primary tumor may carry prognostic information that persists over a follow-up period of roughly a decade.

The study analyzed 332 patients with ER-positive, HER2-negative early-stage breast cancer who were treated between 2008 and 2010. All participants were women with a mean age of 56 years. During a median follow-up of 121 months, 33 patients, or 9.9 percent, experienced a recurrence, and 13 patients, or 3.9 percent, died. The researchers set out to determine whether tumor FDG accumulation on pretreatment PET/CT predicts long-term recurrence-free survival and overall survival in this common breast cancer subtype, and to identify factors linked to early versus late recurrence.

Although 18F-FDG PET/CT has previously demonstrated utility in predicting short-term and mid-term recurrence of breast cancer, its association with long-term prognosis in ER-positive, HER2-negative disease remained unclear before this work.

Methodologically, the team performed univariable and prespecified parsimonious multivariable Cox proportional hazards regression analyses to assess factors associated with recurrence-free survival and overall survival. Tumor SUVmax was analyzed as a continuous variable rather than being dichotomized into high and low categories, which preserves the graded nature of the measurement. To disentangle early from late events, patients were stratified into an early recurrence group, defined as recurrence within five years, and a late recurrence group, defined as recurrence beyond five years.

In multivariable analyses for recurrence-free survival, tumor SUVmax was independently associated with outcome in the clinical stage-based model, with a hazard ratio of 1.48 and a 95 percent confidence interval of 1.34 to 1.63, at a P value below 0.01. In a sensitivity model adjusted for the proliferation marker Ki-67, tumor SUVmax remained independently associated with recurrence-free survival, with a hazard ratio of 1.49 and a 95 percent confidence interval of 1.36 to 1.63. High Ki-67 expression, defined as 20 percent or more, was also independently associated in that model, with a hazard ratio of 2.46 and a 95 percent confidence interval of 1.14 to 5.31, at a P value of 0.02.

For overall survival, tumor SUVmax was the only variable independently associated with outcome in the multivariable analyses, showing a hazard ratio of 1.40 with a 95 percent confidence interval of 1.22 to 1.61 and a P value below 0.01. Because SUVmax was modeled continuously, these hazard ratios describe the change in risk per unit increase in uptake rather than a comparison between fixed patient categories.

The subgroup analyses revealed a temporal split in the biology of recurrence. Early recurrence within five years was associated with tumor SUVmax and high Ki-67 expression in univariable analyses. Late recurrence, by contrast, showed a different pattern: in multivariable analysis, older age, with a hazard ratio of 1.04 per year and a 95 percent confidence interval of 1.01 to 1.07 at a P value of 0.01, and tumor SUVmax, with a hazard ratio of 1.50 and a 95 percent confidence interval of 1.35 to 1.68, were independently associated with recurrence beyond five years.

That clinicopathological factors associated with recurrence differed between early and late recurrence is one of the study’s notable observations.

The authors conclude that pretreatment tumor SUVmax on 18F-FDG PET/CT was associated with long-term recurrence-free survival and overall survival in patients with ER-positive, HER2-negative early-stage breast cancer, and that SUVmax may have potential prognostic value requiring independent validation. As a retrospective single-cohort analysis of 332 patients treated in a limited two-year window, the study establishes an association rather than a causal effect, and the reported hazard ratios should be regarded as estimates from this cohort until confirmed in independent populations.

Published on 19 October 2026 as an open-access research article in Breast Cancer Research, the study is being shared early as a peer-reviewed accepted manuscript that is citable and carries a permanent DOI, with a final version of record to follow.

Subject of Research: Prognostic value of tumor SUVmax on 18F-FDG PET/CT for long-term survival in early-stage ER-positive, HER2-negative breast cancer

Article Title: Prognostic value of tumor maximum standardized uptake value on positron emission tomography/computed tomography for 10-year survival in early-stage estrogen receptor-positive, human epidermal growth factor receptor 2-negative breast cancer: a retrospective study

Article References: Tsukada, H., Tsukada, J., Shimizu, Y., Nogami, M., Nakagawa, A., Noguchi, E., Aoyama, K., & Akashi-Tanaka, S. (2026). Prognostic value of tumor maximum standardized uptake value on positron emission tomography/computed tomography for 10-year survival in early-stage estrogen receptor-positive, human epidermal growth factor receptor 2-negative breast cancer: a retrospective study. Breast Cancer Research. https://doi.org/10.1186/s13058-026-02404-7

Image Credits: AI Generated

DOI: 10.1186/s13058-026-02404-7

Keywords: breast cancer, PET/CT, SUVmax, 18F-FDG, prognosis, recurrence-free survival, overall survival, ER-positive, HER2-negative, Ki-67, retrospective study, late recurrence